Question about increasing from 2x/month to weekly injections

[Mark in Seattle]

I've been on Humira for the 2 loading doses of 4 pens followed by 2 pens. So far no magic bullet. At what point does it make sense to request that my doc increase the frequency to weekly rather than every other week in an attempt to get a response? Or is that even a valid question?

I know I've heard of folks ratcheting up to weekly in order to get back a positive response when the response begins to wane, but if the initial response is weak, is it valid to request weekly rather than 2x/month injections?

Thanks!

 

[Paul Cronk]

I cannot help you but I am about to be faced with the same dilemma. Humira seems not to be working so we may be going for weekly instead of twice monthly. Will this make me twice as tired and twice as likely to have infections? Who knows, but I guess I will try it as the options for treatment are running out.

 

[Aussie]

Hi Mark, there are two situations when you don't respond to biologic therapy.

Primary non-responder : Had the loading dose but never really improved. No point decreasing the dosing interval, the drug doesn't work, suggest change to another medication. In your case, perhaps Infliximab.

Secondary loss of response : initially had a response to the biologic, and then started to lose response, ie. the Humira initially kept you in remission the entire two weeks between doses, and then you start feeling your Crohns coming back before the next injection, and this will usually progressively get worse. In this case, shortening the dose interval would be a reasonable idea.

Best wishes.

 

[Mark in Seattle]

Paul, good luck with inquiring with your doc about this option. Would be interested to hear what you both decide. Does Humira make you tired? So far I've not experienced that at all. I've experienced super-easy sunburning, but that's it.

How long have you been on Humira?

 

[Mark in Seattle]

Aussie, if I understand you correctly, you're saying that if a person does the first and/or second loading dose, but does not get a response, then that person should be considered a primary non-responder and should be considered for a switch to a different med. Maybe I'm misunderstanding you on this point in terms of labeling that person as a non-responder after just the first and/or second loading dose. It seems to me that I've heard that sometimes it takes a few months to get an effect. I was actually really very surprised when I went in for my first loading dose, and my GI told me that he wanted me to commit to Humira for one year before determining that it's not effective. I'll have to spreak with him further about all of this the next time I see him. Committing for a year seems perhaps a bit excessive if it's not doing the trick. Thanks.

 

[Aussie]

Hi Mark, not exactly. If you've finished your entire loading dose, so for Infliximab that would be infusions at week 0 then week 2 then week 6, and you've not noticed any significant improvement before you next infusion is due 8 weeks later, then you would be classed as a primary non-responder. At that stage, you should be thinking of a change in medication, or just ensure that your symptoms are being driven by active Crohns and not something else that wouldn't respond to biologic therapy.

 

[littlemissh]

Hi I started humira in march..I think and had good effect in about 6 weeks but not good enough and my symptoms appeared before my next dose. Because of this my hb still drops and my weight etc so this week I went to weekly injections. I think most gi's would wait at least 3 months as this is the time suggested it takes for full effect. If you had a partial response it may be you would benefit from weekly jabs but if no response it is unlikely an increase would help..as Aussie says.

 

[PsychoJane]

I've also been told about the 3 months period before telling that your treatment is not working and they were even telling me that it worth waiting up to six month (but that was when humira became less effective, that we started the weekly regimen + methotrexate). If you just started with the initial doses, I would give it a bit of time.

 

[Samboi]

It has taken a full six month period for me to get full relief via Humira.
I am now in remission.
My response to it has been a slow build.
I was impatient for quick results - but it has been worth the wait.

 

[Mark in Seattle]

You guys are awesome, thanks for the responses, gives me some food for thought.

 

[Paul Cronk]

Thanks, Samboi. That is what I wanted to hear from someone. Patience is something we all learn with this disease, although that is difficult given the anxiety !